Constipation – A potential cause of malnutrition

Constipation in children is a common health problem affecting 0.7% to 29.6% of children worldwide. Constipation is not simply a symptom of a digestive disorder, but it also has many consequences that affect a child’s nutrition and stature. Detecting and promptly treating constipation is an important condition to prevent malnutrition in young children.

The association between constipation and malnutrition

According to the US National Institute of Health (NIH), constipation is a condition of infrequent bowel movements (less than 2-3 times/week), hard, dry or lumpy stools, difficult bowel movements, Burning pain when defecating, incomplete defecation. In children, the normal number of bowel movements per day varies with each stage: For infants, it is about 3-4 times/day; Toddlers about 2-3 times a day; And from 4 years old onwards, the number of daily bowel movements for children is about 1-2 times until adulthood. Constipation is a common symptom in young children. Children with constipation may have the following symptoms:

– Defecate less than 2 times/week

– Hard, dry or clumpy stools

– Hard or painful defecation

– When your child tells you that the stool hasn’t passed completely

– Change positions to avoid or delay bowel movements, including: standing on tiptoes, squeezing buttocks, performing unusual movements such as dancing

– Abdominal bloating, flatulence

– Night sweats during the day or at night

– Fecal incontinence resembles diarrhea

The cause of constipation in children may come from inappropriate nutrition or psychological abnormalities in children. And a diet low in fiber, low in fruits and vegetables, insufficient water drinking is the main reason why children have difficulty defecating. Since defecation is difficult and painful, many children will tend to hold back their defecation. In addition, there are a number of other psychological problems and children’s habits, such as stress when potty training, embarrassed when using public restrooms, not want to interrupt playtime…

If stool stays too long in the colon,  the fluid is heavily absorbed by the colon. Then the stool becomes hard, dry and difficult to defecate. If your child avoids or delays defecation, he or she may have stool retention and more severe symptoms such as rectal bleeding, blood in the stool, and constant pain and bloating in the lower abdomen, vomiting, and especially weight loss.

There have been many studies showing the relationship between constipation and anorexia in children. A study in the Netherlands by Tharner and colleagues showed a bidirectional relationship between anorexia and constipation. Anorexia and constipation become a vicious cycle when constipated children have bloating and flatulence, which will lead to loss of appetite, poor appetite, bloating, indigestion, poor absorption of nutrients, and vice versa. If children are lazy to eat fruits and vegetables, they have a higher risk of hard stools, causing constipation and micronutrient deficiency.

Constipation and anorexia in children are closely related. (Photo: Freepik)

Both constipation and anorexia can affect a child’s nutritional status and growth rate. A study by H. Chao and colleagues investigated the effectiveness of constipation treatment on anorexia and childhood development. The results showed that after 12 weeks of treating constipation, more than 50% of children with anorexia had better appetite and after 24 weeks, the rate of children with appetite was 70%. In addition, the child’s height, weight, and BMI indicators also improved significantly after 12 weeks of treatment.

It can be seen that timely detection, intervention and treatment of constipation in young children is extremely urgent to prevent malnutrition and ensure children’s growth momentum. So, what are the solutions for constipation in children?

Constipation treatment methods nowadays

Drug treatments: In many cases, treating constipation with enemas and laxatives is the fastest method to treat constipation in children. However, this method should only be applied when prescribed by a doctor due to its potential unwanted effects if not carefully controlled. Many studies show that enemas temporarily disrupt the intestinal microflora balance, causing dehydration and serious electrolyte imbalance if taken without prescription of a doctor, or even cause intestinal infections and inflammation. Thus, the use of medication to treat constipation requires consultation with a doctor to avoid unwanted consequences in young children.

Non-drug treatments:

– Create proper bowel habits for children: Changing children’s bowel habits can help treat constipation. If the child has been potty trained, the caregiver can practice the habit of going to the toilet after meals to form a habit, rewarding the child when they go to the toilet properly.

– Increase physical activity: Increasing physical activity has a good effect on children’s bowel movements. Caregivers can refer to pelvic floor muscle exercises that have been shown to be significantly effective in children with constipation by Farahmand et al. The exercise should be performed twice a day for 8 weeks, including walking in a semi-sitting position (squatting) for 5 minutes. Exercise time was increased by 5 minutes per week for two consecutive weeks and kept the same for the next six weeks. Caregivers can use toys as rewards for children after these exercises.

Increasing physical activity has a good effect on children’s bowel movements. (Photo: Freepik)

– Drink enough water: Providing your child with enough water helps soften the stool, thereby making it easier to pass. Children can be hydrated from food sources such as fruit, porridge, soup or fruit juice.

– Add enough fiber: Fiber has a laxative effect, stimulates intestinal motility and supports digestion. According to recommendations of the Institute of Nutrition, children from 1 – 10 years old need to be supplemented with 19 – 28 g of fiber/day to support digestion.

– Supplement nutrients to support digestion: Prebiotics và Probiotics

Probiotics, also known as beneficial bacteria, have been defined by the Food and Agriculture Organization of the United Nations and the World Health Organization (FAO/WHO) as living microorganisms that when used in appropriate quantities will brings health benefits to the host. According to the International Scientific Association (ISAPP), probiotics are inanimate microorganisms that contain ingredients that provide health benefits. These microorganisms include mainly bacteria but also yeast, and they are naturally present in fermented foods, or can be added to other available food products as dietary supplements. In particular, Postbiotics are by-products of probiotic metabolism, also known as probiotic bacterial fermentation. Postbiotics probiotics are one of the leading solutions in the world, bringing many benefits to a healthy digestive system in children. Postbiotics LBiome probiotic contains inactivated Lactobacillus LB cells to support digestive health, recommended by the European Society of Pediatric Gastroenterology, Hepatology and Nutrition, safe for children 1 month and older. In the intestinal microflora of young children, Postbiotics LBiome probiotics directly impact the intestinal microflora, preventing the invasion of pathogens, while inhibiting the activity of harmful bacteria, helping to balance the intestinal system, thereby stimulating the body’s natural immune system. With many proven scientific studies, Postbiotics LBiome probiotics have a strong impact in helping children’s digestive system stay healthy, improving acute diarrhea and digestive disorders, while also supporting increased resistance. Supplementing Postbiotics probiotics through a healthy and complete diet slowly and reasonably is one of the easiest ways to enhance children’s intestinal microflora. Along with that, using products supplemented with Postbiotics probiotics such as Metacare drinking yogurt with 1 billion Postbiotics LBiome probiotics helps prevent the invasion of pathogens, balances the intestinal microflora and activates the immune system. Natural immune system for children to develop healthily. Thanks to that, children’s resistance is enhanced, digestion is supported, and nutrients are absorbed better.

On the other hand, prebiotic fiber is the substrate (also known as food) for beneficial bacteria to selectively use, contributing to bringing many benefits to the host’s health. They are usually complex carbohydrates (such as inulin and other FOS fructo-oligosaccharides) that microorganisms in the digestive tract use as raw materials for metabolism.

Prebiotics and Probiotics support a healthy digestive system. (Photo: thebodybuildingdietitian)

Many studies show that probiotics reduce constipation in children. A review of 6 studies found that taking probiotics for 3–12 weeks increased urinary frequency in children with constipation, while a 4-week study in 48 children found that probiotic supplementation helps improve frequency and consistency of bowel movements. However, not all probiotics are effective in treating constipation. The following bacterial strains have been shown to improve stool quality : Bifidobacteria lactis; Lactobacillus plantarum; Streptococcus thermophilus; Lactobacillus reuteri; Bifidobacteria longum. While there is no specific recommended dosage for these probiotics, most probiotic supplement packets contain between 1–10 billion CFU per serving. We can get these beneficial bacteria and many other important nutrients from fermented foods like kimchi, kombucha, kefir, natto, tempeh and sauerkraut.

Some prebiotic fibers also contribute to the relief of constipation. For example, Inulin fiber helps stimulate the growth of bacteria in the intestines, enhancing digestive health. A 2016 study by Micka in constipated subjects found that taking 0.4 ounces (12 grams) of inulin from chicory per day may increase stool frequency and stool softness. Some foods that help supplement prebiotics include: chicory, artichokes, asparagus or some supplements containing FOS, GOS or Inulin – these are effective prebiotics for the intestines.

Conclusion

Long-term constipation causes pain, increase the risk of malnutrition and inhibit children’s growth. Therefore, recognizing and having timely interventions to prevent constipation is extremely important in the process of raising children.